Optically guided suprapubic cystostomy

Abstract

A medical instrument and associated functionality are described for performing a cystostomy with optical guidance. A cystostomy device (10) includes a sound (12) including a distal portion (18) and a proximal portion (20), a front handle (14) and a rear handle (16). A physician or other user can grip the handles (14 and 16) to guide the distal portion (18) of the sound (12) through the urethra and into a bladder of the patient. The device (10) includes an optical unit (32) mounted at the tip (22) of the sound (12). The optical unit (32) generally includes a distal sound tip cap (34) with a lens opening and an optical lens (36) mounted on the opening. The optical unit (32) may further include one or more illumination sources, such as LEDs, for illuminating a volume forward of the tip (22) of the sound (12).

1 . A method for use in cystostomy, comprising:
 providing a medical instrument including an instrument body having a proximate portion and a distal portion, and an optical assembly supported on said instrument body, said optical assembly including an optical element, directed forwardly in relation to said distal portion of said instrument body, for use in providing image information for a volume forward of said distal portion of said instrument body, and a light source, directed forwardly from said distal portion of said instrument body, for use in providing illumination of said volume forward of said distal portion of said instrument body; connecting said medical instrument to a display device for displaying images based on said image information; and   using said display device to monitor a cystostomy.   
     
     
         2 . The method of  claim 1 , wherein said medical procedure involves moving said medical instrument on a procedure pathway between a first position, where said distal portion is outside of a bladder of a patient, and a second position, wherein said distal portion is inside of said bladder. 
     
     
         3 . The method of  claim 1 , wherein said using involves monitoring movement of a device separate from said medical instrument relative to a bladder of a patient. 
     
     
         4 . The method of  claim 2 , wherein said medical instrument comprises a trocar having a cutting end and said medical procedure involves advancing said cutting end from said first position to said second position. 
     
     
         5 . The method of  claim 2 , wherein said medical instrument comprises a boom supporting a retractable cutting blade, and said medical procedure involves employing said cutting blade to advance said boom from said second position to said first position. 
     
     
         6 . The method of  claim 1 , wherein said medical instrument further comprises a supply line supported on said instrument body for providing a supply of a substance at said volume forward of said distal portion of said instrument body. The supply line of water used to cleanse surgical pathway from blood and/or tissue to provide visual acuity, such that tissue identification is not impeded, during advancement of trocar through abdomen into bladder. 
     
     
         7 . The method of  claim 6 , wherein said substance comprises water for flushing a procedure pathway. 
     
     
         8 . The method of  claim 6 , wherein said substance comprises a gel for improving imaging by said optical element. 
     
     
         9 . The method of  claim 1 , wherein said cystostomy involves inserting a guide wire through said medical instrument into said patient's bladder. 
     
     
         10 . The method of  claim 9 , wherein said cystostomy further involves using said (Original) guide wire to guide a further medical instrument to said patient's bladder. 
     
     
         11 . The method of  claim 10 , wherein said further medical instrument comprises a catheter. 
     
     
         12 . The method of  claim 1 , wherein said optical assembly functions as a guide wire for guiding insertion of a further device along a surgical path defined by said medical instrument. 
     
     
         13 . The method of  claim 12 , wherein said further device comprises an obturator for widening said surgical path. 
     
     
         14 . An apparatus for use in cystostomy, comprising:
 a medical instrument including an instrument body having a proximate portion and a distal portion, and an optical assembly supported on said instrument body, said optical assembly including an optical element, directed forwardly in relation to said distal portion of said instrument body, for use in providing image information for a volume forward of said distal portion of said instrument body, and a light source, directed forwardly from said distal portion of said instrument body, for use in providing illumination of said volume forward of said distal portion of said instrument body, said medical instrument being adapted for performing a medical procedure involving movement of said medical instrument on a procedure pathway between a first position, where said distal portion is outside of a bladder of a patient, and a second position, wherein said distal portion is inside of said bladder;   a display device for displaying images based on said image information.   
     
     
         15 . The apparatus of  claim 14 , wherein said display device is operative for monitoring movement of a device separate from said medical instrument relative to a bladder of a patient. 
     
     
         16 . The apparatus of  claim 15 , wherein said medical instrument comprises a trocar having a cutting end for cutting a pathway from said first position to said second position. 
     
     
         17 . The apparatus of  claim 15 , wherein said medical instrument comprises a boom supporting a retractable cutting blade operative to advance said boom from said second position to said first position. 
     
     
         18 . The apparatus of  claim 14 , wherein said medical instrument further comprises a supply line supported on said instrument body for providing a supply of a substance at said volume forward of said distal portion of said instrument body. 
     
     
         19 . The apparatus of  claim 18 , wherein said substance comprises water for flushing a procedure pathway. 
     
     
         20 . The apparatus of  claim 18 , wherein said substance comprises a gel for improving imaging by said optical element. 
     
     
         21 . The apparatus of  claim 14 , wherein said instrument body is configured for inserting a guide wire through said medical instrument into said patient's bladder. 
     
     
         22 . The apparatus of  claim 14 , wherein said optical assembly functions as a guide wire for guiding insertion of a further device along a surgical path defined by said medical instrument. 
     
     
         23 . The apparatus of  claim 22 , wherein said further device comprises an obturator for widening said surgical path. 
     
     
         24 - 33 . (canceled)